BOSTON — Seven months after undergoing surgery at Brigham and Women’s Hospital, becoming the first person in the U.S. and second in the world to receive a second face transplant, Carmen Blandin Tarleton is ready to return to her work as an inspirational speaker, confident and inspired about what lies ahead.
Tarleton’s transplant was led by Bohdan Pomahac, MD, director of Plastic Surgery Transplantation at the Brigham, and involved a team of over 40 clinicians. The 20-hour surgery was the 10th performed at the Brigham since 2011 and the 16th nationwide. Tarleton, 52, was listed for her second face transplant in October 2019 after the small vessels that supply blood to the face beneath the skin were injured over time as a result of chronic rejection of her first transplant. This had led to scarring, tightness and associated pain.
“Carmen’s second transplant was a carefully planned and executed operation that provides hope to all patients whose transplant is failing. On behalf of our team, I am thrilled that Carmen continues to recover well,” said Pomahac. “Carmen remains one of the most resilient patients that I have had the opportunity to care for. We call this procedure life-giving, and we are thrilled to offer Carmen the opportunity to return to the type of life that she so richly deserves.”
Tarleton’s first face transplant, in 2013, occurred after she suffered burns to over 80 percent of her body. The burns resulted from a brutal attack by her estranged husband, who doused her with industrial strength lye.
“Many years have passed since my original injury and I have found ways to move forward and enjoy life even more, thanks to this donor, my first donor, and the help of so many others who have contributed to the improvement of my life,” Tarleton said. “A new chapter has started, and I am excited to see what life has in store for me now.”
The Brigham clinical team worked with New England Donor Services (NEDS), the federally designated organ procurement organization responsible for organ and tissue donation in the six New England states, to find the suitable donor match. NEDS facilitates face donation, obtaining permission from the next-of-kin, for authorized organ donors who are deemed a good match by the transplant team.
Recently, Tarleton had the opportunity to speak with the family of the donor, Casey Labrie, and came away inspired after the emotional meeting.
“I have such great appreciation for my donor and donor family for this life-changing gift,” she said. “Their ability to make such a decision in the most difficult of times is a true offering of love to their family member and me, a stranger they did not know. When meeting them, I was so happy for the opportunity to let them know how much they impacted my life for the better.”
Bobbi-Sue Harrington, the representative for the donor family, said, “With the guidance and support of New England Donor Services during our time of extreme grief, we became aware of the benefits of organ donation. It gave us hope in otherwise hopeless moments. When we met Carmen after her transplant, we were struck with the enhanced quality of life she is able to have and are grateful that this gift of donation can make such a positive impact in her life. Carmen is an incredibly positive person, and that’s wonderful to see.”
“All of us are inspired by the donor family,” said Alexandra Glazier, President and CEO of New England Donor Services. “At a time of immense sadness, they could see beyond their personal loss for the benefit of someone they’ve never met. This is what makes donation and transplant so profoundly moving and meaningful.”
Tarleton’s first transplant experience was different from other face transplant patients, in that she was highly sensitized by the lifesaving blood products and tissue grafts she needed as a result of her extreme burn injuries. Immunologically complex, it placed her at a higher risk to reject the transplant. These repeated episodes of rejection caused the injury of the deep blood vessels supplying the transplant, causing chronic scarring.
“Once a patient is highly sensitized, they remain at higher risk of rejection,” said Anil K. Chandraker, MD, director of Renal Transplant Medicine at the Brigham, and a member of the transplant team. “Going into her second face transplant, Carmen was not highly sensitized, not at high risk of rejection, as she had lost nearly all of the HLA antibodies in her blood that had made her previously highly sensitized — likely due to the immunosuppression she had received during the first transplant.”
In addition to the rarity of a second face transplant, Pomahac said the surgery was unique on a couple of other fronts. First, it was marked by an unusually close tissue match from Tarleton’s donor, which lowers her future risk of rejection. Secondly, the surgery progressed differently than the previous ones the Brigham team had performed.
“This will likely serve as a prototype going forward.” said Pomahac. “In addition to the close tissue match, the surgical team paused the transplant approximately 15 hours into the surgery, allowing us to better manage the blood loss, which can interfere with blood clotting during the operation. We completed the surgery the following day, which decreased the time Carmen had to spend in the operating room overall.”
Added Donald J. Annino, Jr., MD, DMD, a surgeon at the Brigham specializing in otolaryngology, “Pausing and then resuming the remainder of the surgery allowed the surgical team to be more efficient and rested. Also, in returning to the OR less than 48 hours after we paused the surgery, swelling and scarring was minimal and the anatomy easily identifiable.”
Research into the abilities of face transplant recipients shows that patients can speak, eat and breathe better after transplant. In a recent study published in the New England Journal of Medicine, reporting on the five-year outcomes for six Brigham patients who have received full or partial face transplants, follow-up data showed improved motor and sensory function. In general, face transplant patients report increased functionality to be able to socially reintegrate in a way that would not have been possible before. Overall, patients had a robust return of motor and sensory function of their faces, and all but one patient reported improvements in their quality of life.
The Brigham has long been recognized as one of the world’s leaders in transplantation, having performed the first successful human organ donor transplant, a kidney, in 1954, the first heart transplant in New England in 1984, and the first heart-lung transplant in Massachusetts in 1992. The Brigham performed the nation’s first full face transplant in 2011.